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Biventricular takotsubo cardiomyopathy with asymmetrical wall motion abnormality between left and right ventricle: a report of new case and literature review

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Abstract

Takotsubo cardiomyopathy (TC) is characterized by transient wall motion abnormalities most commonly involving the left ventricle (LV). Although biventricular TC had been considered uncommon condition, recently biventricular TC has been reported as a new variant observed in 19–42% of all TC presentations. Since biventricular TC has a poor prognosis as compared with isolated TC, it is important to distinguish between isolated LV TC and biventricular TC. We present a case of 70-year-old female with dyspnea persisting for 2 days. Electrocardiogram showed symmetrical T-wave inversion in leads V2–V4. Transthoracic echocardiography (TTE) revealed diffuse hypo-kinesis except for the apical inferior LV and LV ejection fraction of 32%. Hyper-kinesis of the right ventricular (RV) basal segment and dys-kinesis of the RV apical segment. 2 weeks after admission, coronary angiography showed no evidence of significant stenosis. LV ejection fraction improved to 51% and wall motion abnormalities of the RV basal and apical segments were ameliorated to normo-kinesis. Electrocardiogram revealed symmetrical and deepened T-wave inversion in leads V2–V3. The presence of a transient abnormality in biventricular wall motion beyond a single coronary artery perfusion territory with new electrocardiographic change met the diagnostic criteria of definite TC defined by Mayo Clinic criteria. 4 weeks after admission, no recurrence of wall motion abnormalities in both ventricles were found and T-wave inversion ameliorated. To our knowledge, this is the first report of biventricular TC with asymmetrical abnormities of wall motion between LV and RV.

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Authors and Affiliations

  1. Department of Cardiology, Federation of National Public Service Personnel Mutual Aid Association Tachikawa Hospital, 4-2-22, Nishiki-cho, Tachikawa, Tokyo, 190-8531, Japan

    Toshimitsu Tsugu, Yuki Nakajima & Toshimi Kageyama

  2. Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, 359-8513, Japan

    Yuji Nagatomo

  3. Department of Cardiology, School of Medicine, Keio University, Tokyo, 160-8582, Japan

    Jin Endo, Yuji Itabashi & Takashi Kawakami

Authors
  1. Toshimitsu Tsugu
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  2. Yuji Nagatomo
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  3. Yuki Nakajima
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  4. Toshimi Kageyama
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  5. Jin Endo
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  7. Takashi Kawakami
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Correspondence to Toshimitsu Tsugu.

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Toshimitsu Tsugu, Yuji Nagatomo, Yuki Nakajima, Toshimi Kageyama, Jin Endo, Yuji Itabashi, and Takashi Kawakami declare that they have no conflict of interest.

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Tsugu, T., Nagatomo, Y., Nakajima, Y. et al. Biventricular takotsubo cardiomyopathy with asymmetrical wall motion abnormality between left and right ventricle: a report of new case and literature review. J Echocardiogr 17, 123–128 (2019). https://doi.org/10.1007/s12574-019-00424-1

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  • DOI: https://doi.org/10.1007/s12574-019-00424-1

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